Early Dexamethasone in COVID-19 Reduces Mortality for Inpatients on Oxygen Support

Results of a study published in the JAMA Network Open suggest that early treatment with dexamethasone is associated with reduced risk of mortality and discharge to hospice care among patients hospitalized with COVID-19 infection receiving oxygen support.

Researchers conducted a retrospective cohort study between July 2020 and October 2021 to evaluate outcomes of early dexamethasone treatment among different subgroups of patients hospitalized with COVID-19 infection. Eligible patients were those who were hospitalized for at least 48 hours. Early dexamethasone treatment was defined as receipt within 48 hours of admission or initiation of oxygen support. The primary outcomes were all-cause in-hospital mortality and discharge to hospice care. Outcomes were assessed using logistic regression, with adjustments made via propensity score overlap weighting.

A total of 80,699 patients (median age, 64 [IQR, 52-76] years) were included in the analysis. Patients were stratified into 4 subgroups based on type of oxygen support received. Each subgroup included patients who did not receive early dexamethasone treatment (controls).

Patient subgroups included 13,040 (16.2%) who did not require supplemental oxygen (treatment, n=7537; controls, n=5,503); 56,368 (69.8%) who received supplemental oxygen (treatment, n=48579; controls, n=7,789); 7618 (9.4%) who received noninvasive positive pressure ventilation (treatment, n=6,826; controls, n=792); and 3,673 (4.6%) who required mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO; treatment, n=2,660; controls, n=1,013).  

The median duration of dexamethasone treatment ranged from 4 (IQR, 3-6) to 9 (IQR, 5-11) days. The median daily dose ranged from 7.3 (IQR, 6-12) to 11.0 (IQR, 6.1-12) mg. 

Early use of dexamethasone was associated with reductions in both the risk of in-hospital all-cause mortality and discharge to hospice care among patients receiving supplemental oxygen (adjusted odds ratio [aOR], 0.92; 95% CI, 0.86-0.98) and those receiving mechanical ventilation and/or ECMO (aOR, 0.82; 95% CI, 0.68-0.99).

This association between early dexamethasone use and decreased risk of all-cause in-hospital mortality and discharge to hospice care was not observed among patients who required no supplemental oxygen and those receiving noninvasive positive pressure ventilation.

The researchers noted that early dexamethasone treatment was most beneficial among patients with preexisting comorbidities.  

Study limitations include the relatively small number of control patients, as well as the lack of data on vaccination status and time since onset of COVID-19-related symptoms.

According to the researchers, “[D]espite the evolution of the COVID-19 pandemic over time, dexamethasone remains beneficial for these hospitalized patients in a clinical practice setting.”

Disclosures: Multiple authors declared affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Infectious Disease Advisor